Medicine and Health Sciences Commons^™

Patient Guide To Starting A Glp-1 Agonist, Jenna G. Eaton

Family Medicine Clerkship Student Projects

With the increasing prevalence of diabetes and obesity in Vermont, GLP-1 agonists are being prescribed more and more to help treat these conditions. Providers at Milton Family Medicine relayed that they have been prescribing them more as well over the recent years and have seen significant benefit for their patients. With increased use of these medications, patients continue to have many questions around how GLP-1 agonists work, their side effects, and how to pay for these expensive medications. There is a need to have education materials available at the office to answer these questions for our patients.

Towards The Elimination Of Viral Hepatitis In Clinton County, New York, Michael H. Le

Family Medicine Clerkship Student Projects

Chronic viral hepatitis is a major public health issue, affecting approximately 300 million persons globally. In Clinton County, New York, chronic viral hepatitis remains a major concern, with incidence rates for hepatitis C virus infection (HCV) in the top quartile and hepatitis B virus infection (HBV) in the 3rd quartile for the state in 2022. This current study aimed to identify the trends in incidence and prevalence of chronic viral hepatitis in Clinton County, rates of HBV birth dose vaccination, and to reflect on the experiences in treatment and prevention of chronic viral hepatitis at a community health clinic in …

Presentation Of A Peri-Prosthetic Atypical Femur Fracture After Long Term Anti-Resorptive Medication Use, Jennifer B. Bamford, Jennifer Kelly

Larner College of Medicine Faculty Publications

Peri-prosthetic atypical femur fractures are rare. Most are associated with the use of long-term bisphosphonates and other anti-resorptive medications. This case highlights a 74-year-old female treated with approximately 13 years of bisphosphonate therapy followed by a short course of denosumab, who suffered an atraumatic peri-prosthetic fracture after a several month prodrome. This case report's objectives are to show how the prodrome presents, increase recognition of the condition and work up prior to fracture, and emphasize the need to consider drug holidays.

Access To Prep In Plattsburgh, New York (Cvph Family Medicine), Kelly Knight

Family Medicine Clerkship Student Projects

This project examines ways to increase access to HIV pre-exposure prophylaxis (PrEP) in Plattsburgh, New York (located in Clinton County). After a review of the current literature on the subject and interviews with community members, an intervention was conducted at CVPH Family Medicine. EHR tools were generated and distributed to providers in the practice, with the goal of increasing the distribution of patient education materials about PrEP.

Diabetic Foot Wound Care, Richard Q. Vuong

Family Medicine Clerkship Student Projects

Diabetic foot wound care educational pamphlet developed during the family medicine rotation for 3rd-year medical students. This project was developed in Brookfield, CT.

A 2022 Assessment Of Food Security And Health Outcomes During The Covid-19 Pandemic, Ashley C. Mccarthy, Farryl Bertmann, Emily H. Belarmino, Sam Bliss, Jennifer Laurent, Jonathan Malacarne, Scott Merrill, Rachel E. Schattman, Kathryn Yerxa, Meredith T. Niles

College of Agriculture and Life Sciences Faculty Publications

We conducted a Northern New England survey to understand the impacts of the COVID-19 pandemic on food security, food access, home food production, health behaviors, and health outcomes. The surveys were conducted in the spring of 2022 (April-May) with a total of 1,013 adults (598 in Maine and 415 in Vermont) responding to the survey. Key findings include:1. The prevalence of food insecurity remains similarly high to early points in the pandemic, likely driven by inflation and food prices, and long-term impacts from the pandemic. 2. The majority (62%) indicated the recent rise in food prices affected their food purchasing, …

Change In Food Security And Health Outcomes Since The Covid-19 Pandemic In Northern New England, Jennifer Laurent, Farryl Bertmann, Mattie Alpaugh, Emily H. Belarmino, Sam Bliss, Jonathan Malacarne, Ashley C. Mccarthy, Scott C. Merrill, Rachel E. Schattman, Kathryn Yerxa, Meredith T. Niles

College of Nursing and Health Sciences Faculty Publications

We conducted a Northern New England survey in March-June of 2021 to understand the initial and continued impacts of the COVID-19 pandemic on food security, health behaviors, and health outcomes. A total of 988 adults (562 in Maine and 426 in Vermont) responded regarding food access and availability, health behaviors such as diet composition and exercise, and use of habit-forming substances (e.g. alcohol, tobacco, etc.) before and in the year following the onset of the COVID-19 pandemic. Key findings include: 1. 39.1% of Maine and 43.2% of Vermont respondents indicated weight gain since the start of the COVID-19 pandemic. 2. …

Association Of Urine Findings With Metabolic Syndrome Traits In A Population Of Patients With Nephrolithiasis, Virginia L. Hood, Kevan M. Sternberg, Desiree De Waal, John R. Asplin, Carley Mulligan, Peter W. Callas

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

1. Background The odds of nephrolithiasis increase with more metabolic syndrome (MetS) traits. We evaluated associations of metabolic and dietary factors from urine studies and stone composition with MetS traits in a large cohort of stone-forming patients.

   Methods Patients .18 years old who were evaluated for stones with 24-hour urine collections between July 2009 and December 2018 had their records reviewed retrospectively. Patient factors, laboratory values, and diagnoses were identified within 6 months of urine collection and stone composition within 1 year. Four groups with none, one, two, and three or four MetS traits (hypertension, obesity, dyslipidemia, and diabetes) were evaluated. …

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A Family With Neuropathies And An Mfn2 Variant, Leah Miller

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

BACKGROUND: The axonal subtype of Charcot-Marie-Tooth (CMT2A) is commonly caused by dominant mutations in MFN2, which encodes a protein involved in mitochondrial dynamics and axonal transport. Over 100 variants in MFN2 are reportedly pathogenic. MFN2 dysfunction yields heterogenous neuropathies which can include optic atrophy, dysautonomia and diaphragmatic/airway dysfunction.

CASE REPORT: A 52-year-old man presented with a 10-year history of burning forefoot dysthesias and orthostasis. His examination revealed reduced sensation to light touch and pinprick distally with preserved strength and reflexes. NCS/EMG demonstrated mild, symmetric axonal polyneuropathy. Autonomic testing revealed orthostatic tachycardia and postganglionic sudomotor dysfunction. Laboratory evaluation for common causes …

The Effect Of Amphibian Host Ecology And Evolution On The Pathogen Dynamics Of Ranavirus, Lauren V. Ash

Graduate College Dissertations and Theses

Emerging infectious diseases threaten amphibian species around the globe. Ranavirus (Family: Iridoviridae) is associated with the majority of amphibian deaths in North America, with some species exhibiting mass mortality events in short periods of time. In contrast, some amphibian species show the capacity to resist or tolerate infection. Resistant individuals exhibit reduced infection intensity, while tolerant individuals display reduced fitness effects given the infection intensity. My research focused on how amphibian host dynamics at community, population, and individual-level scales relate to the wide variation in Ranavirus prevalence and severity. Through my work, I documented the first reports of Ranavirus in …

Benign Vs. Malignant: Improving Prevention And Detection Of Cancerous Vs. Non-Cancerous Skin Lesions Through Inclusive Patient Education, Simran Kalsi, Sam Afshari

Family Medicine Clerkship Student Projects

Vermont consistently has one of the highest annual rates of melanoma in the United States. This is likely due to a range of factors including population demographics (predominantly white, aging population), active outdoor lifestyles, intense seasonal bursts of sun exposure, and inadequate Winter sun protection. The COVID-19 pandemic and its associated shutdowns have caused significant delays in healthcare delivery, further exacerbating the incidence and severity of melanoma. Primary care providers are therefore an increasingly essential first line of defense in detecting suspicious skin lesions and expediting treatment of skin cancer, but patients should be aware of when to seek evaluation. …

Tackling Access To A Healthier Life, Edom Alemayehu Girma

Family Medicine Clerkship Student Projects

Obesity is a known risk factor for complications during childhood and later in adult life. While numerous factors play a role in the prevalence of obesity, this project focused on better intervention for obesity management in the family medicine clinic located in Plattsburgh, NY. Interviews and literature searches were conducted to determine possible strategies to better assist patients in attaining their sustainable weight loss goals and an overall healthier lifestyle.

Improving Identification Of Dermatological Conditions In Skin Of Color, Sam Afshari B.S., Simran Kalsi M.S.

Family Medicine Clerkship Student Projects

Vermont primary care practitioners are less likely to have experience diagnosing dark skin tones given that the state population is 94.2% white. Only 4.5% of images in general medicine textbooks and 4-19% of images in dermatology textbooks depicted darker skin. Black patients are significantly less likely to see a dermatologist, which highlights the importance of diagnosis at the primary care office.

Dry Eye: Patient Education, Mark Oet

Family Medicine Clerkship Student Projects

Recent literature has shown increased incidence of dry eye and eye strain symptomatology during the COVID-19 pandemic, coinciding with an increase in screen time for almost all populations. This project aims to address this observation at a community level by creating a patient-friendly education pamphlet for Newtown Primary Care about dry eye and digital ocular strain based on American Academy of Ophthalmology guidelines.

Lifestyle Changes In Covid-19 Pandemic And Impact On Modifiable Stroke Risk Factors, Kelly J. Chan

Family Medicine Clerkship Student Projects

Stroke is one of the leading causes of mortality and disability in the USA. Underlying conditions such as hypertension, diabetes and cardiovascular disease predispose an individual to increased risk of stroke. In addition, the Covid-19 pandemic presents many challenges to these patients in terms of active health management and maintenance. A screening tool was developed to assess patient patterns of lifestyle behavioral changes measured by modifiable risk factors for stroke (medical condition management, diet, exercise, and smoking habits).

Microevolution In Staphylococcus Aureus: Does Exposure To Sub-Lethal Levels Of Cinnamon Bark Oil Lead To Changes In Antimicrobial Susceptibility?, Heather Sandra Schuettner

Graduate College Dissertations and Theses

The emergence of antibiotic-resistant and multi-drug resistant bacteria presents a growing global health issue recognized by the World Health Organization and the Centers for Disease Control and Prevention. Infections caused by drug-resistant bacteria are associated with longer hospital stays, higher treatments costs, and increased mortality compared to infections caused by antibiotic-susceptible pathogens. The global increase in antibiotic resistance is driven in part by the misuse and overuse of antibiotics in healthcare and agriculture. Staphylococcus aureus can infect humans and animals, and strains that are resistant to one or more antibiotics are common. Many plant essential oils have antimicrobial properties. Essential …

Microevolution In Staphylococcus Aureus: Does Exposure To Sub-Lethal Levels Of Cinnamon Bark Oil Lead To Changes In Antimicrobial Susceptibility?, Heather Sandra Schuettner

Graduate College Dissertations and Theses

The emergence of antibiotic-resistant and multi-drug resistant bacteria presents a growing global health issue recognized by the World Health Organization and the Centers for Disease Control and Prevention. Infections caused by drug-resistant bacteria are associated with longer hospital stays, higher treatments costs, and increased mortality compared to infections caused by antibiotic-susceptible pathogens. The global increase in antibiotic resistance is driven in part by the misuse and overuse of antibiotics in healthcare and agriculture. Staphylococcus aureus can infect humans and animals, and strains that are resistant to one or more antibiotics are common. Many plant essential oils have antimicrobial properties. Essential …

Community Health Interventions To Reduce The Burden Of Radon-Related Lung Cancer, Benjamin Weaver

Family Medicine Clerkship Student Projects

Exposure to radon is the second leading cause of lung cancer in the United States. One in seven homes in Vermont has elevated levels of radon, but most patients are unaware of radon as a risk factor for lung cancer or that radon testing and mitigation services are available to them. To promote increased testing and mitigation of radon we screened patients presenting to a Family Medicine practice in Vermont about whether they had had these services done in their home. We also developed a patient education resource for providers to give to patients who had more questions about radon …

How Prepped Are Our Providers?: Assessing Vermont Primary Care Providers’ Knowledge And Awareness Of Pre-Exposure Prophylaxis (Prep) Options For Hiv Prevention, Christopher Flynn

Family Medicine Clerkship Student Projects

In recent years, a number of pre-exposure prophylaxis (PrEP) medications and dosing strategies have become available to patients to help prevent human immunodeficiency virus (HIV) infection. The primary objective of this research was to assess current PrEP awareness and prescribing practices of family medicine providers at the Hinesburg Family Medicine practice in Hinesburg, VT.

Barriers And Facilitators To Use Of A Clinical Evidence Technology In The Management Of Skin Problems In Primary Care: Insights From Mixed Methods, Marianne D. Burke Ph.D., Liliane Savard Dpt, Alan Rubin Md, Benjamin Littenberg Md

University Libraries Faculty and Staff Publications

Objective: Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider’s perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial.

Methods: Using a convergent mixed methods design, PCPs completed a …

An Initiative To Educate And Support Young Adults Diagnosed With Hypertension, Page Tomlinson

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

An Initiative to Educate and Support Young Adults Diagnosed with Hypertension

Page Tomlinson, BS, RN, DNPc

Background: Hypertension is a common diagnosis in the US with significant long-term effects. While guidelines for optimal hypertension management exist, young adults lag behind older adults in treatment and control³. The young adult is arguably more capable of lifestyle changes, primarily due to fewer physical limitations than older adults. Promotion of disease self-management is the most effective way to engage young adults in seeking control over their blood pressure^1,2. Lifestyle modification as a young adult decreases costs of care and …

Genitourinary Effects Of Smoking In Men: An Alternative Approach To Smoking Cessation Through Patient Education, Michael J. Lawrence

Family Medicine Clerkship Student Projects

Smoking remains a prominent problem in Vermont, especially outside Chittenden County. The genitourinary effects of smoking tend to be poorly appreciated among patients. This presents an opportunity for further patient education and incentivization to quit. This project focused on the genitourinary effects of smoking in men, specifically highlighting how smoking increases risk of bladder cancer, poorer outcomes in prostate cancer, and a higher risk of erectile dysfunction. The project culminated in creation of an educational poster intended for display in patient bathrooms in a medical setting.

Blood Pressure Management Education, Lauren G. Gernon, Cara Rathmell

Family Medicine Clerkship Student Projects

The expansion of telehealth with COVID-19 and recent recommendations to use at-home blood pressure monitoring to diagnose and monitor hypertension have increased the need for materials and education for clinicians and patients. A pilot project in Primary Care Internal Medicine UVM in Essex, VT, produced an electronic medical record dot phrase and compiled educational materials to initiate nurse visits for at-home BP measurements. Materials and experience with this pilot was researched for initiation of a similar program at UVM Family Medicine Hinesburg.

Increasing Oral Health Care For The Elderly In Plattsburgh, Ny, Megan E. Prue

Family Medicine Clerkship Student Projects

Poor oral hygiene can have many adverse systemic effects in the elderly, including aspiration pneumonia. This project explored ways to increase dental care in the elderly, with the aim of decreasing rates of pneumonia along the way.

Lifestyle Changes During The Covid-19 Pandemic And Their Impacts On Cardiovascular Disease Risk Factors, Francis T. Mtuke

Family Medicine Clerkship Student Projects

The COVID-19 Pandemic has been particularly stressful for a wide array of patients, which has manifested in a number of ways. At the Brookfield Primary Care Clinic in Brookfield, CT, one of the ways that this was most prominent was through the change in the way patients exercised and ate. The impact this will have down the line is unknown, but this study aimed to assess the degree to which these changes have permeated the lives of patients.

Investigating The Involvement Of Runx1 And Hif-1Α In Hypoxia-Induced Epithelial-To-Mesenchymal Transition And Generation Of Breast Cancer Stem Cells, Lizzi Hahn

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

No abstract provided.

Family Medicine Resident Education On Perioperative Management Of Patients On Anticoagulation, Hanna Mathers

Family Medicine Clerkship Student Projects

Family Medicine residents at CMMC in Lewiston, Maine manage patients in an outpatient clinic as well as on an inpatient family medicine teaching service. Many patients in the community are anticoagulated for native valve atrial fibrillation and undergo surgical procedures both in the inpatient and outpatient setting. Residents are often asked on to determine the necessity and timing of anticoagulation discontinuation for patients that they see. With patients on newer oral anticoagulants and various degrees of risk, it can be a challenge to make an informed choice. Residents have found that they would feel more confident in perioperative management of …

Educating Patients On Screening Guidelines And Expectations For Well-Woman Examinations, Cyrus Maxim Jalai

Family Medicine Clerkship Student Projects

Female patients seeing primary care in rural settings often do not seek out specialized care from a practicing OB/GYN, favoring instead to utilize their family practitioner to respond to their complaints. As such, it would be effective to work to educate these patients at their well-women examinations on routine screenings, immunizations, and health maintenance methods they should expect based on their presenting age. A handout simplifying and synthesizing the main screening and general health guidelines for annual well-women examinations may be helpful for female patients using primary care practitioners as their source for obstetric and gynecologic care.

Quality Improvement: Cervical Cancer Screening Rates Within Hudson Headwaters Health Network, Dylon K. Gookin

Family Medicine Clerkship Student Projects

Nearly 8 out of every 100,000 people are diagnosed with cervical cancer each year. However, powerful screening tools exist that enable us to detect and manage cervical changes before they develop into cervical cancer. In spite of this, cervical cancer screening rates remain low for many providers. This public health project sought to identify and address a cause for low cervical cancer screening rates within the Hudson Headwaters Health Network. A literature review determined that education and mailed invitation letters were proven methods for improving cervical cancer screening rates. Following a review of the local population demographics, West Mountain Health …

Bibliometric Analysis Of Scholarly Publications On The Zika Virus, 1952-2016, Frances A. Delwiche

University Libraries Faculty and Staff Publications

The 2015-2016 epidemic in the Americas caused by the Zika Virus (ZIKV) triggered a dramatic increase in the number of scholarly publications on this topic. In an effort to understand and characterize this body of literature, a bibliometric study was conducted on all articles found in PubMed that were published on the Zika virus between 1952 and 2016. Study parameters included publication date, source journal, subject and category of source journal, and country of first author. The data was frequency-ranked, enabling identification of the most highly productive journal titles, subject areas, and countries. The study concluded with a comparison between …